Abstract | BACKGROUND: Luteinized unruptured follicle ( LUF) syndrome is considered a cause of ovulation failure and a subtle cause of infertility. Preovulatory injection of human chorionic gonadotropin (HCG) prevents or treats LUF syndrome, but it has also occurred after the induction of ovulation with clomiphene/HMG and HCG. This study was designed for evaluation and comparison of LUF incidence in eligible infertile women undergoing two stimulation protocols ( clomiphene + HMG and letrozole + HMG) in addition to intrauterine insemination (IUI). Some related factors were compared between LUF and non- LUF cycles as secondary outcomes. METHODS: The study was designed as a prospective randomized controlled trial. Patients were randomized using a table of random numbers into two equal protocol groups. For group A, (n = 90) clomiphene citrate was administrated orally in doses of 100 mg/day, and group B (n = 90) orally received letrozole 5 mg/day from day 3 to 7 of the menstrual cycle. Then HMG 75IU/day was administered intramuscularly in both groups on day 8 of the menstrual cycle and the dose was adjusted on the basis of ovarian response. The optimum size of preovulatory follicles for the injection of HCG (10,000 IU) was considered 18-23 mm. The number and size of preovulatory follicles were assessed by vaginal ultrasound 12 h before HCG (D0). Endometrial thickness was measured as well. IUI was performed on all patients 38-40 h after HCG. The second ultrasound examination was performed to observe the evidence of oocyte releasing at the time of IUI (D1). If the follicles were unruptured, a third sonography was performed on day 7 after HCG (D7) to observe LUF syndrome. RESULTS: There was a significant difference between clomiphene-HMG and letrozole-HMG in LUF (p = 0.021) and pregnancy (p = 0.041). The complete LUF in letrozole-HMG was lower than the alternative group and the pregnancy rate was higher. The patients in the non- LUF group had higher midluteal progesterone and a thicker endometrium compared to LUF cycles (p = 0.039) and (p < 0.001). The results of our multivariate logistic regression indicate that size 18-19.9 mm leads to the complete LUF less than ≥22 mm [AOR: 0.25, P = 0.005], and in size 20- 21.9 mm as well [AOR: 0.17, P = 0.002]. CONCLUSION:
Letrozole, with lower incidences of LUF, is more effective than clomiphene citrate for the induction of ovulation in IUI cycles. In our study, we illustrated that larger follicles of ≥22 mm diameter were associated with higher incidences of LUF. We recommend that further studies investigate and focus on the relationship between follicular size and/or full hormonal profiles and LUF.
|
Authors | Azra Azmoodeh, Mansoureh Pejman Manesh, Firouzeh Akbari Asbagh, Azizeh Ghaseminejad, Zeinab Hamzehgardeshi |
Journal | Global journal of health science
(Glob J Health Sci)
Vol. 8
Issue 4
Pg. 244-52
(Sep 01 2015)
ISSN: 1916-9736 [Print] Canada |
PMID | 26573024
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Aromatase Inhibitors
- Fertility Agents, Female
- Nitriles
- Triazoles
- Clomiphene
- Letrozole
- Luteinizing Hormone
|
Topics |
- Adult
- Aromatase Inhibitors
(administration & dosage)
- Clomiphene
(administration & dosage)
- Female
- Fertility Agents, Female
(administration & dosage)
- Follicular Phase
(drug effects)
- Humans
- Infertility, Female
(therapy)
- Insemination, Artificial
(methods)
- Letrozole
- Luteinizing Hormone
(metabolism)
- Nitriles
(administration & dosage)
- Ovarian Follicle
(drug effects)
- Ovulation Induction
(methods)
- Pregnancy
- Prospective Studies
- Syndrome
- Triazoles
(administration & dosage)
|